Stanford B型主动脉夹层胸主动脉腔内修复术术后截瘫一例并文献复习
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摘要
四川省遂宁市中心医院胸心外科1例Stanford B型主动脉夹层患者行胸主动脉腔内修复术(TEVAR)治疗,术后出现截瘫。经腰大池脑脊液引流(CSFD)术,辅以颅内脱水、改善脊髓供血、抗凝、控制性降压等综合治疗后,患者恢复良好,同时未出现严重并发症,如脊髓腔内出血、感染、漏液、脑疝等。现总结临床资料、治疗经过并复习相关文献。
In Department of Cardiothoracic Surgery, Suining Central Hospital, a patient with Stanford type B aortic dissection was treated by thoracic endovascular aortic repair(TEVAR), which resulted in paraplegia. After cerebrospinal fluid drainage treatment(CSFD) combined with intracranial dehydration, improved spinal cord blood supply,anticoagulation, controlled hypertension and other comprehensive treatment, the patient recovered well without serious complications, such as intraventricular hemorrhage, infection, fluid leakage, cerebral hernia, etc. This paper summarizes the clinical data, treatment course and reviews related literature.
In Department of Cardiothoracic Surgery, Suining Central Hospital, a patient with Stanford type B aortic dissection was treated by thoracic endovascular aortic repair(TEVAR), which resulted in paraplegia. After cerebrospinal fluid drainage treatment(CSFD) combined with intracranial dehydration, improved spinal cord blood supply,anticoagulation, controlled hypertension and other comprehensive treatment, the patient recovered well without serious complications, such as intraventricular hemorrhage, infection, fluid leakage, cerebral hernia, etc. This paper summarizes the clinical data, treatment course and reviews related literature.
引文
[1]易定华,徐志云,王辉山.心脏外科学[M].北京:人民军医出版社,2016.
[2] Crawford ES,Svensson LG,Hess KR,et al. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta[J]. J Vasc Surg,1991,13(1):36-46.
[3] Bisdas T,Panuccio G,Sugimoto M,et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms[J]. J Vasc Surg,2015,61(6):1408-1416.
[4]许冉冉,胡雁秋,沈振亚.脑脊液引流治疗主动脉腔内修复术后并发截瘫的护理[J].护理实践与研究,2018,15(1):74-75.
[5]黎明,舒畅,阎方舟,等.胸主动脉腔内修复术后截瘫发生的危险因素及处理[J].中国普通外科杂志,2016,25(10):1488-1493.
[6]刘建平,夏娟,敬毅,等.基层医院急性主动脉夹层救治策略[J].中国医药导报,2014,11(12):32-35.
[7] Jiménez-Trujillo I,González-Pascual M,Jiménez-García R,et al. Type 2 Diabetes Mellitus and Thoracic Aortic Aneurysm and Dissection:An Observational PopulationBased Study in Spain From 2001 to 2012[J]. Medicine(Baltimore),2016,95(18):e3618.
[8] Al Jabbari O,Abu Saleh WK,Irshad A,et al. Case Report:Delayed Type A Aortic Dissection Following Complete Debranching of the Aortic Arch and Stent Graft Placement[J].Methodist Debakey Cardiovas J,2016,12(1):45-47.
[9] B觟ckler D,Brunkwall J,Taylor PR,et al. Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft:Early and 2 year Results from a European Multicentre Registry[J]. Eur J Vasc Endovasc Surg,2016,51(6):791-800.
[10] Schmitto JD,Fleissner F,Hanke J,et al. Repair of an acute Type A aortic dissection with LVAD patient after failed mitral and tricuspid operation[J]. Clin Case Rep,2016,4(4):387-389.
[11]刘建平,何元军,张永恒,等.覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的临床分析[J].中国医药指南,2013,11(5):19-21.
[12] Klocker J,Koell A,Erlmeier M,et al. Ischemia and functional status of the left arm and quality of life after left subclavian artery coverage during stent grafting of thoracic aortic diseases[J]. J Vasc Surg,2014,60(1):64-69.
[13] Miyazaki Y,Furuyama T,Matsubara Y,et al. Thoracic endovascul ar aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis[J]. Surg Case Rep,2016,2(1):38.
[14] Qin YL,Deng G,Li TX,et al. Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection[J]. J Vasc Surg,2012,56(5):1232-1238.
[15]冯翔,景在平,包俊敏,等.脊髓动脉造影预防胸主动脉夹层动脉瘤腔内隔绝术后截瘫[J].第二军医大学学报,2002,23(7):716-718.
[16]陈菲,邵涓涓,贾明,等.全胸腹主动脉置换术后脊髓缺血的临床分析[J].心肺血管病杂志,2015,34(9):694-697.
[17] Lazorthes G,Gouaze A,Zadeh JO,et al. Arterial vascularization of the spinal cord:recent studies of the anastomotic substitution pathways[J]. J Neurosurg,1971,35(3):253-262.
[18] N′da HA,Chenin L,Capel C,et al. Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction[J]. Surg Radiol Anat,2016,38(5):563-567.
[19] Baril DT,Carroccio A,Ellozy SH,et al. Endovascular thoracic aortic repair and previous or concomitant abdominal aortic repair:is the increased risk of spinal cord ischemia real?[J]. Ann Vasc Surg,2006,20(2):188-194.
[20] Koleilat I,Moore E,Hanover T,et al. An unusual cause of spinal cord ischemia after thoracic endovascular repair[J].Vascular,2016,24(2):194-196.
[21] Kamada T,Yoshioka K,Tanaka R,et al. Strategy for thoracic endovascular aortic repair based on collateral circulation to the artery of Adamkiewicz[J]. Surg Today,2016,46(9):1024-1030.
[22]余惠,曹舸,范景秀.腰大池引流脑脊液治疗主动脉夹层术后截瘫六例[J].中国胸心血管外科临床杂志,2017,24(9):738-739.
[23] Feezor RJ,Martin TD,Hess PJ,et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair[J]. The Ann Thorac Surg,2008,86(6):1809-1814.
[24] Colman MW,Hornicek FJ,Schwab JH. Spinal Cord Blood Supply and Its Surgical Implications[J]. J Am Acad Orthop Surg,2015,23(10):581-591.
[25] Dias NV,Sonesson B,Kristmundsson T,et al. Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms[J]. Eur J Vasc Endovasc Surg,2015,49(4):403-409.
[26]冯睿,景在平,包俊敏,等.Stanford B型主动脉夹层动脉瘤腔内隔绝术后截瘫的预防对策[J].介入放射学杂志,2003,12(4):254-256.
[2] Crawford ES,Svensson LG,Hess KR,et al. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta[J]. J Vasc Surg,1991,13(1):36-46.
[3] Bisdas T,Panuccio G,Sugimoto M,et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms[J]. J Vasc Surg,2015,61(6):1408-1416.
[4]许冉冉,胡雁秋,沈振亚.脑脊液引流治疗主动脉腔内修复术后并发截瘫的护理[J].护理实践与研究,2018,15(1):74-75.
[5]黎明,舒畅,阎方舟,等.胸主动脉腔内修复术后截瘫发生的危险因素及处理[J].中国普通外科杂志,2016,25(10):1488-1493.
[6]刘建平,夏娟,敬毅,等.基层医院急性主动脉夹层救治策略[J].中国医药导报,2014,11(12):32-35.
[7] Jiménez-Trujillo I,González-Pascual M,Jiménez-García R,et al. Type 2 Diabetes Mellitus and Thoracic Aortic Aneurysm and Dissection:An Observational PopulationBased Study in Spain From 2001 to 2012[J]. Medicine(Baltimore),2016,95(18):e3618.
[8] Al Jabbari O,Abu Saleh WK,Irshad A,et al. Case Report:Delayed Type A Aortic Dissection Following Complete Debranching of the Aortic Arch and Stent Graft Placement[J].Methodist Debakey Cardiovas J,2016,12(1):45-47.
[9] B觟ckler D,Brunkwall J,Taylor PR,et al. Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft:Early and 2 year Results from a European Multicentre Registry[J]. Eur J Vasc Endovasc Surg,2016,51(6):791-800.
[10] Schmitto JD,Fleissner F,Hanke J,et al. Repair of an acute Type A aortic dissection with LVAD patient after failed mitral and tricuspid operation[J]. Clin Case Rep,2016,4(4):387-389.
[11]刘建平,何元军,张永恒,等.覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的临床分析[J].中国医药指南,2013,11(5):19-21.
[12] Klocker J,Koell A,Erlmeier M,et al. Ischemia and functional status of the left arm and quality of life after left subclavian artery coverage during stent grafting of thoracic aortic diseases[J]. J Vasc Surg,2014,60(1):64-69.
[13] Miyazaki Y,Furuyama T,Matsubara Y,et al. Thoracic endovascul ar aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis[J]. Surg Case Rep,2016,2(1):38.
[14] Qin YL,Deng G,Li TX,et al. Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection[J]. J Vasc Surg,2012,56(5):1232-1238.
[15]冯翔,景在平,包俊敏,等.脊髓动脉造影预防胸主动脉夹层动脉瘤腔内隔绝术后截瘫[J].第二军医大学学报,2002,23(7):716-718.
[16]陈菲,邵涓涓,贾明,等.全胸腹主动脉置换术后脊髓缺血的临床分析[J].心肺血管病杂志,2015,34(9):694-697.
[17] Lazorthes G,Gouaze A,Zadeh JO,et al. Arterial vascularization of the spinal cord:recent studies of the anastomotic substitution pathways[J]. J Neurosurg,1971,35(3):253-262.
[18] N′da HA,Chenin L,Capel C,et al. Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction[J]. Surg Radiol Anat,2016,38(5):563-567.
[19] Baril DT,Carroccio A,Ellozy SH,et al. Endovascular thoracic aortic repair and previous or concomitant abdominal aortic repair:is the increased risk of spinal cord ischemia real?[J]. Ann Vasc Surg,2006,20(2):188-194.
[20] Koleilat I,Moore E,Hanover T,et al. An unusual cause of spinal cord ischemia after thoracic endovascular repair[J].Vascular,2016,24(2):194-196.
[21] Kamada T,Yoshioka K,Tanaka R,et al. Strategy for thoracic endovascular aortic repair based on collateral circulation to the artery of Adamkiewicz[J]. Surg Today,2016,46(9):1024-1030.
[22]余惠,曹舸,范景秀.腰大池引流脑脊液治疗主动脉夹层术后截瘫六例[J].中国胸心血管外科临床杂志,2017,24(9):738-739.
[23] Feezor RJ,Martin TD,Hess PJ,et al. Extent of aortic coverage and incidence of spinal cord ischemia after thoracic endovascular aneurysm repair[J]. The Ann Thorac Surg,2008,86(6):1809-1814.
[24] Colman MW,Hornicek FJ,Schwab JH. Spinal Cord Blood Supply and Its Surgical Implications[J]. J Am Acad Orthop Surg,2015,23(10):581-591.
[25] Dias NV,Sonesson B,Kristmundsson T,et al. Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms[J]. Eur J Vasc Endovasc Surg,2015,49(4):403-409.
[26]冯睿,景在平,包俊敏,等.Stanford B型主动脉夹层动脉瘤腔内隔绝术后截瘫的预防对策[J].介入放射学杂志,2003,12(4):254-256.